Incidence of Anaplastic Large-Cell Lymphoma of the Breast in the US, 2000 to 2018

Connor J. Kinslow; Arreum Kim; Gloria I. Sanchez; Simon K. Cheng; Lisa A. Kachnic; Alfred I. Neugut; David P. Horowitz

doi:10.1001/jamaoncol.2022.2624

Research Letter

July 21, 2022

Incidence of Anaplastic Large-Cell Lymphoma of the Breast in the US, 2000 to 2018

Connor J. Kinslow, MD¹; Arreum Kim, MS, MSBS^2,3,4; Gloria I. Sanchez, PhD⁵; et al Simon K. Cheng, MD, PhD^1,4; Lisa A. Kachnic, MD^1,4; Alfred I. Neugut, MD, PhD, MPH^2,3,4; David P. Horowitz, MD^1,4

Author Affiliations Article Information

¹Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
²Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
³Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
⁴Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
⁵Group of Infection and Cancer, School of Medicine, University of Antioquia, Medellín, Colombia

JAMA Oncol. 2022;8(9):1354-1356. doi:10.1001/jamaoncol.2022.2624

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Anaplastic large-cell lymphoma (ALCL) of the breast is a rare malignant condition, representing approximately 3% of breast lymphomas,¹ and has been identified as a possible adverse effect of breast implants.¹ In 2020, the Food and Drug Administration (FDA) mandated a black box warning on the labeling of all saline- and silicone gel–filled implants warning of an association with ALCL. The incidence of breast ALCL has increased in Australia and New Zealand² and the Netherlands,³ which is thought to be secondary to an increased use of textured implants. However, to our knowledge, there are no current population-based estimates of the incidence of breast ALCL in the US.

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August 5, 2022

Race or Ethnicity Disparity in the Incidence of Anaplastic Large-Cell Lymphoma of the Breast from 2000 to 2019

Jinjun Ran, PhD | School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

In this issue of JAMA Oncology, Kinslow et al1 present that the age-adjusted incidence rate of breast anaplastic large-cell lymphoma in females was rapidly increasing from 3.2 per 100 million persons per year during 2000-2005 to 14.5 per 100 million during 2012-2018. However, the disparity in race or ethnicity was not further investigated. Filling the gap would make the study more comprehensive and complete.

We retrieved data from 2000 through 2019 from the Surveillance, Epidemiology, and End Results 22 database (covering approximately 47.9% of the US population). Similar to the methodology in Kinslow’s study,1 primary breast ALCL was identified based on the International Classification of Diseases for Oncology, Third Edition codes 9714 and topographic codes C50.0-50.9. We reproduced the consistent overall results with the published paper, and then examined the annual age-adjusted incidence rates (per 100 million) in female breast ALCL by race or ethnicity, including non-Hispanic White, non-Hispanic Black, and Hispanic (the 2000 US standard population for age-adjustment). According to our observation, race or ethnicity disparity was found in the incidence trend in primary breast ALCL among US females. Specifically, for non-Hispanic White women, the incidence rate was 1.3 per 100 million persons per year (95% CI, 0.3-4.0) in 2000-2004, and 25.8 per 100 million (95% CI, 19.4-33.7) in 2015-2019 (P < .001). For Hispanic women, the incidence rate were 1.1 (95% CI, 0.0-8.8) and 14.3 (95% CI, 7.4-24.9) per 100 million per year in 2000-2004 and 2015-2019, respectively (P = .008). Conversely, the incidence remained stable among non-Hispanic Black women with an incidence of 8.3 (95% CI, 1.6-24.1) in 2000-2004 and 7.7 (95% CI, 1.6-21.6) in 2015-2019, respectively (P = .94).

The rising incidence of primary breast ALCL was probably related to the increasing prevalence of textured implants in the US.2 And with the rapid popularity of textured implants among US females,3 primary breast ALCL would raise a huge public-health concern. However, to date, race or ethnicity disparity in the incidence of primary breast ALCL is not well understood. The race/ethnicity-conscious research approach may contribute to better medical strategies in prevention, treatment, and public health education and promotion.

References
1. Kinslow CJ, Kim A, Sanchez GI, et al. Incidence of Anaplastic Large-Cell Lymphoma of the Breast in the US, 2000 to 2018. JAMA Oncol. Jul 21 2022;doi:10.1001/jamaoncol.2022.2624
2. de Boer M, van Leeuwen FE, Hauptmann M, et al. Breast Implants and the Risk of Anaplastic Large-Cell Lymphoma in the Breast. JAMA Oncol. Mar 1 2018;4(3):335-341. doi:10.1001/jamaoncol.2017.4510
3. Tandon VJ, DeLong MR, Ballard TN, et al. Evolving Trends in Textured Implant Use for Cosmetic Augmentation in the United States. Plast Reconstr Surg. Dec 2018;142(6):1456-1461. doi:10.1097/PRS.0000000000004977

Race or Ethnicity Disparity in the Incidence of Anaplastic Large-Cell Lymphoma of the Breast from 2000 to 2019

Haoting Shi, MD
Jinjun Ran, PhD*

Author Affiliation: Department of Radiation Therapy, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China (Haoting Shi); School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China (Jinjun Ran)

*Corresponding Author: Jinjun Ran, PhD, School of Public Health, Shanghai Jiao Tong University School of Medicine, 413 East No. 1 Bldg, 227 South Chongqing Rd, Shanghai 200025, China (jinjunr@sjtu.edu.cn).

CONFLICT OF INTEREST: None Reported

Incidence of Anaplastic Large-Cell Lymphoma of the Breast in the US, 2000 to 2018

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